Applies to:

Group commercial HMO, EPO, POS and PPO plans

Individual commercial MyPriority^® plans

Medicare

Medicaid Healthy MI Plan

Medical policy

• Telemedicine - 91604

Refer to the medical policy for medical necessity criteria, services not covered as virtual services, and coding information.

Use of virtual visits for behavioral health services

Please note: Effective Jul. 1, 2020, all audio-only visits must be billed using audio-only visit codes (99441 - 99443, 98966 - 98968). No other codes can be billed for audio-only visits. You should bill for these visits using the place of service you normally would, based on your office location.

From the medical policy, page 5:

Telemedicine visits for acute life-threatening medical conditions or psychotherapy may be restricted to hosted sites where the patient can be monitored or assisted by an onsite provider. Behavioral health services in settings other than hosted sites should be limited to stable patients with straightforward needs. Patients with acute psychiatric needs or patients requiring ongoing psychotherapy beyond crisis stabilization may not be candidates for telemedicine. 

Virtual service billing

Refer to the medical policy for most coding information. These links will take you to service-specific pages.

• Mental health outpatient codes
• Care management codes
• Phone and e-visit codes
• Virtual monitoring codes